The answer to this question is not straight forward and depends on many factors. What is your disease type, location and severity? Are there other complications such as fistulas, strictures or abscesses? Are you or your child in the hospital? Some of the answers to these questions may indicate that diet could be an excellent next step, other answers might indicate that one needs to start medication or needs a more immediate intervention than diet. 

In addition to disease type and severity, it is important to evaluate other aspects. I always say to my patients that “a working therapy (whether medication or diet) has to work from a quality of life, symptom and disease perspective. If it is not working for one of these aspects, it may not be the right therapy for that individual." You or your child have to be willing to try diet modification and elimination. We find that selective or “picky” eaters who LOVE their traditional diet may struggle with a diet like the specific carbohydrate diet (SCD) and thrive with a therapy such as exclusive enteral nutrition (EEN). It is important to understand the various dietary therapies available.

In my personal experience I have seen patients successfully wean off of their medication and manage inflammation with diet alone. I have also seen the reverse where inflammation returns as medication is weaned. With some medications, the concern is that it will no longer be a viable medication option once weaned as the body can built antibodies to the medication. This would mean a potential new medication therapy if inflammation returned and antibodies were created. It is very important to partner with a GI doctor who is willing to monitor and support these medication changes.

Diet therapy is not necessarily forever but treating your inflammation IS. The goal with most of the elimination diets out there is to be a starting point that can be expanded upon over time. Inflammatory bowel disease is a life-long inflammatory condition that requires treatment. If left untreated, inflammation can wreak havoc. We tell patients that a therapy is not forever (whether diet or medication). If it is not working, there are new therapy options being researched as we speak. Some individuals love dietary therapy during one stage of life, but struggle with it during another. An example of this is grade school aged children transitioning to teenage years and wanting the freedoms that come with going out with friends independently.

We cannot speak for your specific provider, but we know many believe that there is not enough data or evidence to substantiate elimination diets (aside from EEN which DOES have the larger studies and data). Most studies are limited to one center with small population sizes. This is changing, however, as larger, multi-center studies are developed and executed. 

Additionally, many practitioners do not have practice and training implementing a diet therapy and therefore, do not have the experience to see patients in remission through diet. 

Find your team! IBD impacts all aspects of life and inflammation can be triggered through the environment, stress, and/or diet. A multidisciplinary team is crucial. I highly recommend in addition to your GI provider and dietitian trained in diet therapy/ies, that you also involve a mental health provider specialized in GI disorders and/or specialized diets used in treating disease. You or your child will run up against the real struggles of eating out, holiday gatherings and celebrations that you will have to navigate. 

Prepare in advance to transition to the diet and have a plan in place to execute it. Some dietary therapies require re-stocking your pantry and thinking of a new way of cooking. If you like details, it is important to discuss the big picture so you know where you are beginning and the end goal. Ensure your child is involved in the decision-making process as much as possible.